Tuberculosis non-communicable disease comorbidity and multimorbidity in public primary care patients in South Africa.

Karl Peltzer

doi:10.4102/phcfm.v10i1.1651

Abstract

BackgroundLittle is known about the prevalence of non-communicable disease (NCD) multimorbidity among tuberculosis (TB) patients in Africa.Aim and settingThe aim of this study was to assess the prevalence of NCD multimorbidity, its pattern and impact on adverse health outcomes among patients with TB in public primary care in three selected districts of South Africa.MethodsIn a cross-sectional survey, new TB and TB retreatment patients were interviewed, and medical records assessed in consecutive sampling within 1 month of anti-TB treatment. The sample included 4207 (54.5% men and 45.5% women) TB patients from 42 primary care clinics in three districts. Multimorbidity was measured as the simultaneous presence of two or more of 10 chronic conditions, including myocardial infarction or angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, dyslipidaemia, malignant neoplasms, tobacco and alcohol-use disorder.ResultsThe prevalence of comorbidity (with one NCD) was 26.9% and multimorbidity (with two or more NCDs) was 25.3%. We identified three patterns of multimorbidity: (1) cardio-metabolic disorders; (2) respiratory disorders, arthritis and cancer; and (3) substance-use disorders. The likelihood of multimorbidity was higher in older age, among men, and was lower in those with higher education and socio-economic status. The prevalence of physical health decreased, and common mental disorders and post-traumatic stress disorder increased with an increase in the number of chronic conditions.ConclusionHigh NCD comorbidity and multimorbidity were found among TB patients predicted by socio-economic disparity.

Highlights

The global burden of non-communicable diseases (NCDs), in particular cancer, cardiovascular disease, diabetes and chronic respiratory disease, accounts for two-thirds of mortality worldwide,[1] and the fastest increase in NCDs has been recorded in low- and middle-income countries, in sub-Saharan Africa.[2]
As found in a previous study among NCD primary care patients in South Africa,[7] this study found that significant unmet treatment needs existed, ranging from 25.0% for ischaemic heart disease or angina, 27.4% for hypertension, 33.9% for type 2 diabetes to 97.7% for alcoholuse disorders
Contrary to some previous studies,[9,14,15] this study found an association between male gender and TB-NCD multimorbidity

Summary

Introduction

The global burden of non-communicable diseases (NCDs), in particular cancer, cardiovascular disease, diabetes and chronic respiratory disease, accounts for two-thirds of mortality worldwide,[1] and the fastest increase in NCDs has been recorded in low- and middle-income countries, in sub-Saharan Africa.[2] This rapid increase of NCDs may be because of an ageing population, rapid urbanisation, changes in environmental factors and lifestyle changes.[3,4] South Africa is confronted with a large burden of disease from both chronic infections and NCDs.. ‘People living with chronic communicable diseases such as tuberculosis (TB) and human immunodeficiency virus (HIV) are most likely to develop comorbidity with NCDs’.6. Little is known about the prevalence of non-communicable disease (NCD) multimorbidity among tuberculosis (TB) patients in Africa

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